ABI7700、7500荧光定量PCR仪性能评价

目的 对美国ABI 7700、7500荧光定量PCR仪的主要性能指标进行评价.方法 按照美国临床实验室标准化委员会(NCCLS)制定的评价标准,对20份标本(HBV-DNA)定量检测,评价两种仪器的精密度、准确性、线性、可比性、灵敏度等指标.结果 精密度:ABI 7700批内变异系数(CV)为3.67%～5.58%,批问为4.46%～6.53%;7500批内CV为4.09%～5.61%,批间为4.73%～6.96%.准确性:与标准质控物比较,相对偏差7700为0.93%,7500为2.97%.线性:ABI 7700 r=0.999,7500 r=0.995.灵敏度:ABI 7700、7500能检测到的最低HBV-DNA浓度均为1000 U/ml.两种仪器的可比性:相关系数为0.994,直线回归方程为.y=1.0694x-0.1372.结论 两种荧光定量PCR仪各种指标性能均良好.     

荧光定量PCR仪检测乙型肝炎病毒核酸的性能验证及评价

目的荧光定量聚合酶链反应(PCR)仪检测乙型肝炎病毒核酸(HBV DNA)的性能验证及评价。方法参考ISO15189《医学实验室质量和能力认可准则(2012年)》,以及美国临床和实验室标准化协会(CLSL)EP系列文件的相关要求对实验室HBV DNA荧光定量PCR检测系统的精密度、正确度、可报告范围、抗干扰能力进行验证及评价。结果精密度:HBV DNA定量检测高浓度(106 IU/mL)和低浓度(103 IU/mL)标本的对数值批内变异系数分别为0.67%和3.65%,批间变异系数分别为1.72%和4.52%;正确度:标准物质标本检测结果的对数值与厂商给定靶值浓度的对数值差值在±0.4个Log值内;可报告范围:试验试剂在(2.22×10)～(2.22×108)IU/mL范围内具有良好的线性,线性回归方程为Y=1.027 X-0.408,R2=0.995,≥0.95;抗干扰能力:说明书浓度的干扰物质(血红蛋白、三酰甘油、胆红素)标本结果与不含干扰物质标本比较,其浓度的对数值偏倚CV7.5%,对数值差值在±0.4个Log值内。结论荧光定量PCR仪检测HBV DNA试剂的各项性能特征与厂家声明相符,满足预期用途,适用于临床常规检测。     

罗氏LightCycler Nano荧光定量PCR仪性能评价

目的对美国罗氏公司LightCycler Nano 32孔荧光定量聚合酶链反应(PCR)仪的主要性能指标进行评价。方法按照美国临床实验室标准化协会(CLSI)制定的评价标准,评价仪器精密度、准确度、灵敏度、可报告范围、仪器间比对等指标。结果LightCycler Nano精密度批内变异系数(CV)为2.63%、1.51%,批间CV为6.2%、4.15%;准确度与室间质控物比较,5个标本均在靶值区间内;灵敏度检测CV≤10%;可报告范围为最大稀释比例1∶100;与比对仪器的比对结果偏差结果均小于15%。结论罗氏LightCycler Nano荧光定量PCR仪5项性能经验证后与厂家提供的性能参数相符,可以用于临床检测。     

丙型肝炎病毒核酸荧光定量检测法的性能验证

目的对基于QIGEN cube全自动核酸提取仪与ABI 7500核酸扩增仪的丙型肝炎病毒(HCV)-RNA定量检测系统进行性能评估。方法参照《临床实验室对商品定量试剂盒》WS/T 420-2013的性能验证方案,采用质量控制(质控)血清与临床标本评价所用商品试剂盒的精密度、正确度、线性范围与检测下限;同时参照《医学实验室质量和能力认可准则在分子诊断领域的应用说明》标准,统计分析实验偏差并与厂家声明的性能指标进行比较。结果精密度验证结果显示,2个浓度水平(level 1、level 2)质控品的批内变异系数(CV_(批内))分别为0.3%、0.9%,批间变异系数(CV_(批间))分别为0.4%、1.11%,均小于厂家声明值(5%)。线性范围试验显示,在1.0×10~2～1.0×10~8 kU/L范围内呈良好线性(R~2=0.999,P0.001),高于厂家声明区间(2.0×10~1～1.0×10~9 kU/L)。正确度验证结果显示,室间质评中的5个浓度水平质控品的实测值与质控样本理论值间偏倚分别为0.10、0、0、0.26和0.26,均小于0.4对数值(log值)。最低定量检测下限为1.0×10~2 kU/L,高于厂家声明的最低检测限(0.5×10~2 kU/L),但与定量限(1.0×10~2 kU/L)一致。结论本实验室建立的HCV-RNA定量检测系统在精密度、正确度、线性范围与检测下限方面的性能指标均满足卫生行业标准与ISO 15189医学实验室质量认可准则的要求,能为临床提供可靠的检验报告。     

荧光定量PCR检测巨细胞病毒DNA试剂盒的性能验证及评价

目的 对实验室新开展项目巨细胞病毒核酸(CMV-DNA)进行性能验证.方法 采用荧光定量PCR仪检测CMV-DNA含量,对精密度、检出限、正确度、线性范围进行验证及评价.结果 CMV的高浓度和低浓度样本批内与批间精密度的变异系数(CV)平均值均<5％,符合规定标准.检出限验证时,重复检测浓度为(1.00E+03)copy/mL,检出率为100％,符合要求.正确度线性R2为0.9987,在(2.40E+03)～(2.26E+07)copy/mL范围内,线性关系良好,符合要求.结论 CMV-DNA试剂盒的主要性能指标已达到相关标准的要求,可在临床上应用.     

4种型号便携式血糖仪的性能评价

目的了解四种型号的便携式(POCT)血糖仪的精密度和正确度性能,为选购和使用提供参考。方法 A、B、C、D型共4台POCT血糖仪进行精密度评价;四种型号29台血糖仪与全自动生化分析仪检测结果比对进行正确度评价。结果 A、B、C型血糖仪批内精密度变异系数CV批内=2.65%~3.91%,日间精密度中、高浓度分别为CV日间=2.95%~3.58%和CV日间=3.43%~4.06%;D型血糖仪批内精密度CV批内=5.91%~6.15%;日间精密度CV日间=5.67%~6.33%。A、B、C、D型血糖仪与全自动生化分析仪检测结果的相关系数分别为0.963 7~0.992 4、0.970 6~0.992 2、0.995 3、0.927 6。按相关规范和美国临床和实验室标准协会(CLSI)准则要求,当血糖浓度小于4.2mmol/L时,结果偏差大于0.83mmol无一例;≥4.2mmol/L时,偏倚小于20%的,A型占94.3%、B型占94.7%,D型占40%,均未达到要求,C型占100%。在低浓度医学决定水平的偏倚大于10%的有16台;中、高浓度医学决定水平的偏倚均(1台除外)小于10%。结论不同品牌型号POCT血糖仪检测性能差别悬殊,使用时需谨慎判读结果。     

LightCycler 480Ⅱ型实时荧光定量PCR仪性能评价

目的对Roche LightCycler 480Ⅱ型实时荧光定量PCR仪(Roche 480)主要性能指标进行评价,为该仪器检测结果的可靠性提供依据。方法按照美国临床实验室标准化委员会(CLSI)文件制定的评价标准,分别对40例标准血清和40例临床标本定量检测HBV-DNA,评价其精密度、准确度、灵敏度、线性和可比性。结果精密度:批内变异系数(CV批内)为1.40%～2.10%,批间变异系数(CV批间)1.17%～1.40%,总变异系数(CV)为1.40%～1.83%;准确度:与标准品比较,相对偏差为0.35%～0.41%;灵敏度:对血清HBV-DNA浓度大于或等于4×103IU/mL的标本检出率为100%,对血清HBV-DNA浓度为4×102IU/mL的标本检出率为90%;线性:相关系数为0.999,直线回归方程为Y=1.0073X-0.0487;Roche480和Roche Light-Cycler1.2(Roche1.2)2台PCR仪的可比性:P=0.113,相关系数为0.995,线性比对直线回归方程为Y=0.9230X+0.3397。结论 Roche 480具有良好的精密度、准确度、灵敏度、线性,与Roche1.2检测系统有良好的相关性,能够满足临床需要。     

商品定量试剂盒分析性能的验证试验

目的 验证部分商品定量试剂盒的主要分析性能。 方法 根据我国卫生部“医疗机构临床实验室管理办法”和CLSI指南文件EP6的要求,对部分商品定量试剂盒进行精密度、正确度和可报告范围的验证试验。 结果 各商品定量试剂盒的批内、批间精密度CV值分别为0.51%～3.20%、0.61%～4.80%均小于厂家CV值;正确度试验结果的平均偏倚值（0.40%～5.36%）均低于厂家偏倚值及CLIA′88规定的允许误差的1/2;各项目的可报告范围试验测定值结果与预测值接近,相关系数r＞0.975,线性理想（斜率b接近1）。 结论 本研究验证的商品定量试剂盒的精密度、正确度和可报告范围3方面均达到了临床应用的实验要求。     

商品定量试剂盒分析性能的验证试验

目的 验证部分商品定量试剂盒的主要分析性能。 方法 〗根据我国卫生部“医疗机构临床实验室管理办法”和NCCLS指南文件EP6-A的要求,对部分商品定量试剂盒进行精密度、正确度和可报告范围的验证试验。 结果 各商品定量试剂盒的批内、批间精密度CV值分别为0.51%～3.20%、0.61%～4.80%,均小于厂家CV值;正确度试验结果的平均偏倚值（0.40%～5.36%）均低于厂家偏倚值及CLIA′88规定的允许误差的1/2;各项目的可报告范围试验测定值结果与预测值接近,相关系数r＞0.975,线性理想（斜率b接近1）。 结论 本研究验证的商品定量试剂盒的精密度、正确度和可报告范围3方面均达到了临床应用的实验要求。     

电化学发光技术测定25羟基维生素D的性能验证

目的对电化学发光技术检测25羟基维生素D项目进行性能验证,以确保实验室检测结果的准确。方法依据国家标准文件,对电化学发光技术检测25羟基维生素D的精密度、正确度、线性范围、参考区间进行验证试验。结果高、低浓度的批内变异系数(CV)分别为3.18%和3.38%,批间变异系数分别是13.37%和6.23%,均小于厂家声明的不精密度或验证值;正确度验证试验偏倚未超过原卫生部规定的最大允许误差的1/2;验证的线性范围为3.165~48.515ng/mL;参考范围验证20份体检标本检测结果均在厂家提供的参考区间内。结论电化学发光技术检测25羟基维生素D项目性能验证通过,可用于临床检测。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.